Delayed lower extremity paresis following iliosacral screws: Atypical complication and treatment.

Percutaneous iliosacral screw placement has become the technique of choice for treating injuries to the posterior pelvis. However, the technique requires an understanding of the anatomy surrounding the bone corridors to avoid complications and detect them early if they occur. We present the clinical case of a patient with a U-shaped fracture of the sacrum that evolves with gluteal pain and left foot equine paresis after percutaneous fixation with iliosacral screws. Angio-CT of the pelvis shows active arterial bleeding from the superior gluteal artery associated to extensive hematoma in the thickness of the gluteus medius muscle. Emergency embolization is performed by installing coil and gelatin. Successful control of bleeding is achieved. To avoid this complication, a complete imaging study is recommended in planning the surgery and to avoid multiple repositioning of the guide or screw. Arterial injury should be suspected in case of increasing pain despite analgesia, functional impairment or neurological deficit and the angiographic study and resolution by selective embolization of the bleeding vessels must be performed.

Morphological abnormalities of the hip in acetabular fractures.

Poor prognosis factors in surgical treatment of acetabular fracture-dislocations have been well established but there is little information about how morphological abnormalities of the hip may affect the surgical outcome. Hip anatomy has a wide range of variations. Morphological abnormalities of the hip can also be observed in patients with acetabular fractures. We present a case of a complication in a patient with a complex acetabular fracture, acetabular retroversion and femoroacetabular impingement. A 31-year old male patient was transferred to our trauma center following a high speed road traffic accident. Trauma series CT revealed cerebral contusion, subdural hematoma, aortic dissection and a left transverse plus posterior wall acetabular fracture. The left hip was reduced and the acetabular fracture was treated with a Kocher Langenbeck approach in prone position. The pelvic X- ray evidenced an anatomic reduction and signs of acetabular retroversion with positive posterior wall sign and crossover sign. CT scan evidenced increased alpha angle in the femoral head neck junction. During the follow up, 2 months after the acetabular fixation, patient suffered a posterior left hip dislocation and a total cementless hip arthroplasty was performed. Patients with acetabular retroversion and femoroacetabular impingement (CAM lesion) may be at risk of posterior dislocation. The influence of acetabular version and impingement may be also closely involved in how challenging the determination of hip stability can be in patients with posterior wall acetabular fractures. Acetabular retroversion and FAI may be related to the dislocation of unstable patterns with small fragments (wall sizes less than 20%). In this case postoperative precautions were not enough. We believe capsular reattachment with anchors and bracing may be useful in these selected cases. As these patients are not candidates for retroPAO (the recommended treatment for acetabular retroversion) maybe arthroscopic anterior wall riming and CAM resection should be performed at an early stage to decrease or avoid fulcrum.

Ultrasonidos en anestesia locorregional. Fundamentos de la técnica e identificación de nervios periféricos / No disponible

El uso de ultrasonidos en anestesia locorregional se está convirtiendo en un estándar en la práctica clínica habitual. Aumentan la seguridad y en índice de éxitos de los bloqueos, sin embargo y como todas las técnicas, tiene limitaciones evidentes, derivadas fundamentalmente de las limitaciones técnicas y artefactos en la imagen que los ultrasonidos pueden provocar. En este artículo revisamos los principios físicos en los que se basan los ultrasonidos, y analizamos sus posibilidades y limitaciones, así como la forma de explorar nervios periféricos (AU)

The use of ultrasounds is becoming a standard in the clinical practice of locoregional anesthesia. They increase the rate of successful blocks and improve their security, but the ultrasound shave limitations due technical principles and the possibility of artefacts in the image. In this paper we review the basics of the physics of ultrasonography, their possibilities and limitations and the use of ultrasonography in the location of peripherals nerves (AU)

De la infección a la sepsis. Parte II. Impacto genético / From infection to sepsis. Part II. Genetic impact

La sepsis continua siendo una de las causas fundamentales de muerte –posiblemente la más importante- en nuestro medio habitual de trabajo, puesto que frecuentemente los pacientes oncológicos, politraumatizados o con patología cardiovascular y neurológica, fallecen debido a un fallo multiorgánico secundario a una infección. No están claras, sin embargo, las razones por las que una infección evoluciona o no a sepsis y a fallo multiorgánico, aunque parece que los factores genéticos pueden ser muy importantes en esta evolución. En esta segunda parte de la revisión, pretendemos analizar la información más significativa sobre el impacto de algunos polimorfismos en el riesgo de sufrir una sepsis severa o shock séptico, y en la evolución de esta enfermedad una vez establecida (AU)

Sepsis is still one of the major causes of death, maybe the most important one in our work environment, where our oncologic, polytraumatized, neurologic, or cardiac patients often die due to a multiorganic failure secondary to an infection. However, the reason for the evolution from infection to sepsis or even multiorganic failure remain unclear –although genetic factor can be very important developing this clinical condition. In the second part of this review we pretend to analyze the most significant information about the impact of some polymorphisms, involved in the risk of developing severe sepsis or septic shock, and their outcome when established (AU)

De la infección a la sepsis. Parte I. Mecanismos de inmunidad y daño tisular / From infection to sepsis. Part I. Immunologic mechanisms and tisular damage

La sepsis continúa siendo una de las causas fundamentales de muerte –posiblemente la más importante– en nuestro medio habitual de trabajo, puesto que frecuentemente los pacientes oncológicos, politraumatizados o con patología cardiovascular y neurológica fallecen debido a un fallo multiorgánico secundario a una infección. No están claras, sin embargo, las razones por las que una infección evoluciona o no a sepsis y a fallo multiorgánico. En esta revisión, que hemos dividido en dos partes, no pretendemos profundizar ni en la clínica ni el tratamiento de la sepsis, pretendemos revisar los conceptos fisiopatológicos implicados en la protección y daño celulares y tisulares. En la segunda parte prestaremos una especial dedicación a la información existente en la actualidad sobre la implicación de algunos genes en el pronóstico de estos enfermos (AU)

Sepsis is still one of the major causes of death, maybe the most important one in our work environment, where our oncologic, polytraumatized, neurologic, or cardiac patients often die due to a multiorganic failure secondary to an infection. However, the reasons for the evolution from infection to sepsis or even multiorganic failure remain unclear. In this two part review we don’t pretend to go into the clinical presentation and treatment of sepsis in depth, but to look through the physiopathologic features involved in cellular and tisular damage and protection. Moreover, in the second part we will pay special attention to the existing information about the role of certain genes in the outcome of these patients (AU)